Tuesday, April 15, 2014

Anesthesiologists Will Work For Cheap

The ASA has regularly, loudly, and up to now, ineffectively complained about Medicare's inequitable treatment of anesthesiologists. While other medical specialties receive Medicare reimbursements that are typically about 80% that of private insurance, anesthesiologists receive only about one third what insurance would bring us. This payment disparity is apparent in the just released Medicare doc pay database and it couldn't be more stark or disheartening.

Bloomberg organized by specialty the Medicare reimbursements received by doctors. It then ranked the specialties by the total payments received. Not surprisingly, primary care fields topped the list of most money reimbursed by Medicare. What I found more interesting was the amount given per participating physician in each specialty. According to this categorization, anesthesiologists were the second lowest paid physicians by Medicare in 2012, with a per doctor payment of $27,931. Anesthesiologists came in just above the basement occupied by OB/GYN who each received $13,515. Since Medicare is mainly health insurance for the elderly and disabled, there aren't many expensive deliveries being performed in that cohort.

Anesthesiologists raked in less money than non MD's like speech pathologists ($36,615) and physical therapists ($49,064). We rank just above occupations like optometrists ($26,667) and clinical psychologists ($24,420). Physicians that are closest to anesthesiologists in this hall of shame are pediatricians ($31,319) and psychiatrists ($33,853). By comparison ophthalmologists and oncologists each pulled in over $300,000 per physician that year.

CRNA's faired surprisingly poorly with Medicare reimbursements. They averaged only $12,587 per anesthetist in 2012. Whether that is because they take care of younger and healthier patients than anesthesiologists is hard to say.

Another interesting nugget of information from this list is that only 32,641 anesthesiologists participated in the Medicare program in 2012. The ASA tells us that there are over 45,000 anesthesiologists actively practicing in the U.S. So why are only two thirds of them accepting Medicare? Do they practice in ASC's that don't accept Medicare patients? Do they refuse to accept Medicare into their personal practice? Is this some sort of covert resistance movement against a government that unfairly undervalues our services?

So next time your surgeon ($48,655) complains about how little he is making from Medicare for doing another midnight acute abdomen, just tell him you too can feel his pain.